When your parent needs regular help at home, one early choice is who the helper works for. Each path changes who screens the caregiver, who covers a sick day, and who handles the paperwork.
This guide compares those hiring models using Oregon’s own sources. To vet a specific person or company, see our guide to choosing a caregiver.
What are the main ways to hire in-home help in Oregon?
- Hire a caregiver yourself and pay privately. You’re the employer.
- Use a licensed in-home care agency. You can pay privately, or a state program can pay.
- Use a homecare worker your parent chooses and directs, paid through Medicaid long-term services, Oregon Project Independence (OPI), or OPI-Medicaid (OPI-M).
- Use one of two options that sit in between: the Independent Choices Program or the newer Agency with Choice. Both are only for people on Medicaid long-term services.
What does it mean to hire a caregiver yourself?
Hiring privately gives you the most control, but the employer jobs are yours. Oregon’s Aging and Disability Resource Connection (ADRC) lists the jobs an agency would otherwise take on: taxes, vacations, and background checks.
Taxes are real here. The IRS counts caretakers and health aides as household employees when you control both what work is done and how it’s done. In 2026, Social Security and Medicare taxes generally apply once you pay any one household worker $3,000 or more in cash wages. Some family members, such as a spouse, are exempt. IRS Publication 926 or a tax professional can tell you what you owe.
When a private caregiver is sick, quits, or goes on vacation, you’re the backup. And Carina, the site Oregon uses to match homecare workers with people on Medicaid in-home services, OPI, or OPI-M, is built for those programs. The ADRC points families who pay privately to other resources for interviewing and hiring.
Under Oregon Health Authority rules, a business that provides in-home care and schedules caregivers, sets their pay, or places a caregiver with a client needs an in-home care agency license. If a service offers to place someone in your parent’s home, ask to see its license. A business that only does housekeeping, laundry, or errands doesn’t need one.
What does a licensed in-home care agency do?
With an agency, the agency is the employer. The ADRC says it assigns you a caregiver, schedules visits, and is responsible for employer taxes. The Oregon Department of Human Services (ODHS) says the agency screens, interviews, and hires its workers.
Oregon’s rules require agencies to have written service plans, caregiver training, and criminal records checks. Each agency’s license class also sets what its caregivers may do. A limited-class agency can remind your parent to take medications. A basic agency can also assist with them, but only intermediate and comprehensive agencies can administer them. Our guide to Oregon’s in-home care license classes explains the four levels.
The trade-off is cost. The ADRC says agencies tend to cost more than individual homecare workers. It also notes that some agencies provide backup when the regular caregiver is ill or on vacation, so ask how each agency handles it.
What is a Medicaid homecare worker?
In the Consumer Employer Program, ODHS says you hire and manage your in-home workers. You’re the employer, but the program pays your workers directly. It’s open to people on Medicaid long-term services, OPI, or OPI-M.
Before a homecare worker can be paid, they must be at least 18, pass a background check, and attend an orientation within 90 days of getting a provider number, among other steps. ODHS says your parent, as consumer-employer, sets the schedule, decides how and when tasks are done, approves hours worked, and trains and supervises.
There are limits. A homecare worker can only do tasks on your parent’s task list. ODHS gives yard work, pet care, and home repairs as examples of things Medicaid won’t pay a homecare worker to do. Our guide to Medicaid home care in Oregon covers how eligibility and hours work.
Independent Choices and Agency with Choice
The Independent Choices Program gives your parent a monthly cash benefit, and you pay the workers yourselves. ODHS says you can hire who you want, including homecare workers, a spouse, or other family members. Rules differ by program, so confirm with the case manager. With Agency with Choice, the agency employs the worker, and your parent selects, trains, and directs them. The agency handles hiring, background checks, taxes, and pay, and ODHS says it helps coordinate backup coverage if the regular worker is out.
How do the options compare?
- Who’s the employer: you, when you hire privately. The agency, with a licensed agency. Your parent, as consumer-employer, with a homecare worker. With Agency with Choice, the agency employs the worker and your parent directs the care.
- Who handles taxes and background checks: you, when you hire privately. The agency, with a licensed agency or Agency with Choice. A homecare worker must pass a background check to enroll, and the program pays them directly. Ask the case manager how taxes are handled.
- Who covers a sick day: you, with a private hire. With a homecare worker, your parent is the employer, so ask the case manager how backup works. With Agency with Choice, the agency helps coordinate backup. With a licensed agency, ask, since only some provide it.
- Who pays: your family, for private hire. Your family or a state program, for an agency. The state program, for a homecare worker, though OPI may charge a sliding-scale fee based on income.
Which option fits your family?
- You have a trusted person in mind and the time to manage payroll and backup: private hire can work.
- You live far away, work full time, or can’t be the backup: an agency carries more of the load.
- Your parent may qualify for Medicaid, OPI, or OPI-M: call the ADRC first. The program can pay a homecare worker or an agency.
- A relative wants to be paid for the care they already give: ask the case manager about the homecare worker and Independent Choices options.
- Your parent needs hands-on personal care or medication help as needs grow: check an agency’s license class early, so you aren’t switching later.
Many families mix models. A relative covers some days, and an agency covers the rest or provides respite care.
How do we start with a state-funded option?
Call the ADRC at 1-855-673-2372. It’s the statewide line for long-term care options. If your parent already gets Medicaid, OPI, or OPI-M in-home services and you’d like agency care, the ADRC says to ask their case manager.
How Pasha can help
Pasha Health is an in-home care agency. Your parent gets a written care plan and one assigned caregiver for regular visits. 24-hour care is covered by a small team. Care can include personal care, around-the-home help, companionship, respite, overnight and 24-hour care, and post-hospital recovery. Nurse-delegated tasks are done under doctor’s orders. Our founder has spent 14 years in dementia care, and Pasha Health accepts Medicaid.
Take the 2-minute assessment or schedule a 15-minute call, and we’ll talk through what your family needs.
Questions families ask
Does Oregon have a consumer directed personal assistance program?
Not under that name. Oregon has three options that let your parent choose and direct their own worker: the Consumer Employer Program, the Independent Choices Program, and Agency with Choice. Each one requires state program eligibility. The ADRC at 1-855-673-2372 can tell you which ones your parent may qualify for.
Can we use Carina if we pay privately?
Not through Carina. The ADRC says Carina is for people on Medicaid, OPI, or OPI-M in-home services, and it points private payers to other resources on interviewing, hiring, and managing an in-home worker.
Can a family member be paid to care for my parent?
Often, yes, if your parent qualifies for a state program. ODHS says family members and friends can be paid as homecare workers, and the Independent Choices Program lets your parent hire a spouse or other family members. Rules and paid hours differ by program and depend on your parent’s needs assessment, so ask the case manager.
Does an agency caregiver count as our household employee?
Usually not. The IRS says that when an agency provides the worker and controls what work is done and how, the worker isn’t your employee. If you hire someone directly and control the work, they likely are. IRS Publication 926 explains the rules, or ask a tax professional.